Dissociation is a psychological phenomenon that involves a disconnection between a person's thoughts, emotions, memories, or sense of identity. It is a common way of coping with traumatic or stressful situations, allowing a person to distance themselves from the overwhelming emotions and experiences.
Dissociation is better understood as an umbrella term for various types of dissociation. Dissociation can be mild, such as the everyday experiences of daydreaming, getting lost in thoughts, or getting lost in a book or movie, or more severe, where a person acts without memory or a sense of purpose, as if they are sleepwalking.
Three types of Dissociative Disorders
1. Depersonalisation/Derealisation Disorder
This involves significant and ongoing experiences of depersonalisation or derealisation
Depersonalisation involves experiences of unreality or detachment from one’s:
It can feel as though you are outside your body (either beside or above) and watching events happen to you.
Derealisation involves experiences of unreality or detachment from one’s surroundings. People experiencing derealisation often feel as if people, objects, and the world around them are not real.
Both depersonalisation and derealisation can occur in the absence of a dissociative disorder, for example as part of extreme stress, Panic Disorder or PTSD.
Many people describe depersonalisation and derealisation as terrifying, and the experience can leave them anxious and distressed long after it has passed.
2. Dissociative Amnesia
This involves significant gaps in memory about yourself or your life, and is usually related to a traumatic or stressful event. Dissociative amnesia can be:
- Localised – where the person can't remember an event or period of time. This is the most common type of dissociative amnesia
- Selective – where the person can't remember a specific aspect of an event or some events within a period of time
- Generalised – where the person loses all memory of their identity and life history. This form of dissociative amnesia is extremely rare.
Dissociative amnesia is associated with childhood trauma, particularly physical and sexual abuse. People may not be aware of their memory loss or may have only limited awareness until prompted with reminders.
3. Dissociative Identity Disorder (DID)
DID, previously known as Multiple Personality Disorder (MPD), occurs when someone has two or more separate personalities (or identities) as a result of:
- Overwhelming experiences
- Traumatic events
- And/or abuse
When present, each identity shapes the person’s behaviour and has its own personal traits, preferences, and history. DID can involve gaps in memory and hallucinations.
Diagnostic criteria for DID
- The existence of two or more distinct identities (also known as personality states) that are accompanied by changes in behaviour, memory and thinking. These changes may be noticed by others or reported by the person
- Ongoing gaps in memory about everyday events, personal information and/or past traumatic events
- The symptoms cause significant distress or problems in social, occupational or other areas of functioning
Shifts between identities are often unwanted and involuntary, and can be distressing. People with DID may feel that they have suddenly become observers of their own speech and actions, or their bodies may feel different (for example, like that of a different gender or a young child). It is important to keep in mind that although these alternate states may feel or appear to be very different, they are all parts of a single, whole person.
Other terms used to describe these alternate states include:
- Alternate personalities
- Alters
- States of consciousness
- Identities
Many people play down what they are experiencing because of anxiety and shame.
What Dissociation Can Look Like
Dissociative experiences can show up in many ways, including:
- Feeling detached from one's emotions, thoughts, or body
- Memory gaps or amnesia for specific events, people, or periods
- Difficulty recognising oneself in the mirror or feeling disconnected from one's body
- Experiencing a sense of unreality or feeling as if the world around you is distorted or unreal
- Switching between different identities or personality states (in cases of DID)
Dissociation sits on a continuum, and not everyone who experiences dissociation will meet the criteria for a dissociative disorder.
Dissociation Causes and Contributing Factors
Dissociation is often linked to traumatic or highly stressful experiences, such as:
- Childhood abuse or neglect
- Emotional, physical, or sexual trauma
- Natural disasters or accidents
- Prolonged stress or adversity
Dissociation is the brain’s way of making overwhelming stress or trauma bearable, by allowing a person to disconnect from painful emotions and memories. However, when dissociation becomes a habit, it can start to get in the way, for example making it hard to feel good emotions as well as painful ones, even when you would like to. Over time it can also lead to the development of dissociative disorders.
Support Options for Dissociation and Dissociative Disorders
Support for dissociation and dissociative disorders often involves a combination of psychotherapy, self-help strategies, and sometimes medication. Some common approaches include:
- Cognitive Behavioural Therapy (CBT), psychodynamic therapy, and Dialectical Behaviour Therapy (DBT) can help people understand their dissociation and feel more in control of it
- CBT based Trauma Therapy, Imagery Rescripting (ImRS), and Eye Movement Desensitisation and Reprocessing (EMDR) are all designed to help people process and integrate traumatic memories, which can help those experiencing dissociation related to trauma
- Parts Work Therapy (drawn from Internal Family Systems therapy, Ego States Work, and Gestalt Therapy) can be helpful for people with DID. Parts work views the self as made up of inner parts. These inner parts are not multiple personalities but the sum of a unified whole. Parts work aims to address the differences and conflicts between parts (eg. child vs. adult self) as a way to integrate all parts of the self
- Medication - Antidepressants, anti-anxiety medications, or mood stabilisers may be prescribed to help with co-occurring difficulties such as depression or anxiety
- Support groups - Connecting with others who have experienced dissociation can provide valuable emotional support and practical coping strategies.
Tips for Managing Dissociation and Dissociative Disorders
- Develop grounding techniques, such as deep breathing, mindfulness, or focusing on physical sensations, to help reconnect with the present moment when you notice yourself dissociating, and practise them daily
- Create a safe and supportive environment to minimise triggers and stressors that may contribute to dissociation
- Establish a consistent daily routine to promote a sense of stability and predictability
- Try to reduce blame and shame by reminding yourself that it is not your fault
- Develop a plan for when you dissociate
- Seek professional support to work through any underlying trauma or stressors contributing to dissociative experiences
Dissociation can have a big impact on daily life and wellbeing. Understanding where it comes from and what support is available can help people take steps towards feeling more present and connected, and find other ways of coping. If dissociation is affecting you or someone you know, it can help to reach out to a mental health professional experienced in working with dissociation.
